by Holly Hutton, 2014

Graduate, East West School of Planetary Herbology

Introduction:

Cannabis is considered under Federal law as a class I Controlled Substance, although in many states it is legal under medical marijuana laws.   This monograph will concentrate on cannabis’s topical efficacy citing both historical and contemporary uses.  I have only recently begun working with cannabis topically and am pleased at its analgesic properties.  Anecdotal reports from users indicate that it helps alleviate mild to sever muscle spasms.  Due to issues of legality, its medicinal attributes have only recently begun to be studied in depth. Prior studies were based largely upon its negative characteristics with recent research focusing its potential medicinal value.

As herbalists, our materia medica encompasses many different plants. Cannabis sativa L. is just that, a plant that has chemical constituents and actions, like the hundreds of other plants that we use in our clinical practices.  As laws change and there is greater acceptance of its medicinal value, I believe that it will return to a place in our materia medica.  Recently the American Herbal Guild (AHG) surveyed its professional members on the medical use of cannabis.  Seventy-nine percent of AHG members reported that if there were not a legal moratorium on cannabis they would use it clinically.[1]  Twenty states now have medical marijuana available to residents and in two other states it is considered legal, this is an opportune time to increase our knowledge of its positive and negative traits.

Botany and Taxonomy:

The historical and contemporary botany and taxonomic history of cannabis is as convoluted as is its legal status.  Modern botany holds the view that there is only one species-Cannabis sativa L.[2]

Kingdom: Plantae
Division: Magnoliophyta
Class: Magnoliopsida
Order: Rosales
Family: Cannabaceae
Genus: Cannabis

Cannabis — Cannabis sativa L.
Sub-species:
C. sativa subsp. sativa —
C. sativa subsp. sativa var. sativa
C. sativa subsp. sativa var. spontanea

C. sativa subsp. indica
C. sativa subsp. indica var. indica
C. sativa subsp. indica var. kafiristanica

Common names:  marijuana, weed, grass, pot, ganga, hemp, sinsemellia, skunkweed, herb, as well as, many other names through out the world

Chemical Constituents:

The Cannabis plant and its products consist of an enormous variety of chemicals. 483 compounds identified are unique to cannabis.  For example, there are more than 100 cannabinoids[3], a group of C 21 terpenophenolic compounds. [4] Cannabinoids are highly lipophilic, permeate cell membranes and have the ability to cross the blood-brain barrier when inhaled and ingested.  Cannabinoids are metabolized in the liver.  The major metabolite is 11-hydroxy-δ9THC, which is more potent than δ-9THC and may be responsible for some of the psychological and physiological effects of cannabis.[5]  The following is a summary of activity of primary phytocannabinoids [6], [7]

Compound		Pharmacological Characteristics
Cannabigerolic Acid	CBGA	Antibiotic
Cannabigerol	CBG	Antibiotic, Antifungal, Anti-inflammatory, Analgesic, GABA uptake inhibitor, Reduces keratinocytes proliferation in psoriasis, Effective against MRSA,
Cannabichromene	CBC	Antibiotic, Antifungal, Anti-inflammatory, Analgesic (weak),
Cannabidolic Acid	CBDA	Antibiotic
Cannabidiol	CBD	Anxiolytic, Antipsychotic, Analgesic, Anti-inflammatory, Antioxidant, Antispasmodic, Anti-emetic, Antifungal, Anticonvulsant, Antidepressant, Antagonizes effects of THC, Decreases sebum/sebocytes proliferation, effective against methicillin-resistant staphylococcus aureus, pro-apoptotic against breast cancer cell lines
Cannabinol	CBN	Sedative, Antibiotic, Anti-convulsant, Anti-inflammatory, Decreases breast cancer resistant protein, effective against MRSA,
Delta-9 tetrahydrocannabinol	THC	Euphoriant, Analgesic, Anti-inflammatory, Antioxidant, Antiemetic, Antipruritic, Bronchodilator
Delta 9 tetrahydrocannabivarin	THCV	Analgesic, Euphoriant, Anticonvulsant in vitro

The human body produces endocannabinoids, its own natural version of cannabinoids.  Cannabinoid receptors are found throughout the body, especially in the nervous and immune systems. The endocannabinoid system is involved in a variety of physiological processes including appetite, pain-sensation, sleep, mood and memory. Endocannabinoids and cannabinoid receptors respond to biological events-for example, endocannabinoid levels will rise in response to brain injury, strokes, nerve injuries and associated pain. Both plant cannabinoids and endocannabinoids bind to the body’s cannabinoid receptors. When this binding occurs, effects such as pain relief and the suppression of stress result.

Non-cannabinoid type constituents:  The scent of Cannabis results from about 200 different terpenoids. Terpenoids share a precursor with phytocannabinoids, and are the flavor and fragrance components common to human diets. Terpenoids are potent and affect animal and even human behavior when inhaled from ambient air.  Terpenoids display unique therapeutic effects that may contribute to the effects of cannabis-based medicinal extracts. There have been recent studies on the phytocannabinoid-terpenoid interaction, which could produce synergy with respect to treatment of pain, inflammation, depression, anxiety, addiction, epilepsy, cancer, fungal and bacterial infections (including methicillin-resistant Staphylococcus aureus).[8]

Other constituents of the cannabis plant include: nitrogenous compounds (27 known), amino acids (18), proteins (3), glycoproteins (6), enzymes (2), sugars and related compounds (34), hydrocarbons (50), simple alcohols (7), aldehydes (13), ketones (13), simple acids (21), fatty acids (22), simple esters (12), lactones (1), steroids (11), non-cannabinoid phenols (25), flavonoids (29), vitamins (1) [Vitamin A], pigments (2), and elements (9).[9] [10]

Identifying characteristics of the plant:

Cannabis is an annual, dioecious, flowering herb. The leaves are palmate, with serrate leaf edges and have a peculiar and diagnostic venation pattern.  Each serrated leaf has a central vein extending to its tip. Staminate (male) plants are usually taller but less robust than pistillate (female) plants. Mature height ranges from 1 to 5 meters. The flowers have five tepals, and five anthers that hang at maturity, dispersing their pollen to the wind. The female plant has shorter branches and dense growth of leaves and flower-associated bracts. A single achene is produced per flower.  The life cycle of the male is completed soon after anthesis; the female survives until full seed ripeness if pollination happens. Cannabinoids and terpenoids are secreted by glandular trichomes that occur on the floral calyxes and bracts of female plants.

Historical Uses:

For more than 6,000 years cannabis and humans have crossed paths.  The oldest archeological record of cannabis was in central Europe in the Bylony Culture.[11]   Archeological evidence points to shamanic use.  Cannabis may have been the first cultivated plant.  Cannabis sativa seeds were recovered in Neolithic band ceramic in Thüringen, Germany. [12]  In addition to shamanic use, it was used for paper, textiles, food and medicine throughout human history.

The ancient emperor, Shen-Nung (c.2700 B.C.), is known as the Father of Chinese Medicine. He was concerned about the suffering of his subjects; and looked to plants for cures. According to legend, Shen-Nung tried poisons and their antidotes to experience their effect and then compiled the medical encyclopedia called, Pen Ts’ao. The Pen Ts’ao lists hundreds of drugs derived from vegetable, animal and mineral sources. Among these drugs is the plant cannabis know as Ma.  Ma was a unique plant because it was consider both feminine, or yin, and masculine, or yang. Realizing that the female plant produced more medicine, the Chinese cultivated it instead of the male plant. Ma was used to treat female weaknesses (menstruation), gout, rheumatism, malaria, beriberi, constipation, and absentmindedness.[13]  A famous physician, Hua T’o (110-207) A.D.), was known to use ma-fei-san (hemp boiling compound), with wine to anesthetize his patients during surgical operations on the abdominal organs. [14]

Many other cultures have a history of cannabis use.  The Scythians, an Iranian tribe inhabiting large areas in the central Eurasian steppes from the 7th century BC up until the 4th century AD used cannabis for fiber and oil.  According to Herodotus, a Greek historian, there was evidence that they used it as a narcotic in their steam baths.  In India, historical medical literature has some of the earliest accounts of its medicinal utilization.  It was used in combination with henbane as an anesthetic for surgery.  They also used cannabis preparations externally as antiseptics and analgesics.

In Hellenic and Arabic medicine [15] cannabis extracts were used for irrigation of diseases of the anus and as compresses for sore toenails. Arabic medical traditions used cannabis both externally and internally for a variety of conditions for example an ointment combined with fat was applied antiseptically.   In Egypt, according to Rhamses’ papyrus, cannabis was used for the washing of sore eyes. [16] Cannabis shoots were well known to Galen and to Dioscorides.[17]

The medicinal properties of cannabis became part of Western medicine in the mid-19 century when, cannabis strains from Egypt and India were imported by the French and British.  Between 1840 and 1940, English, Irish, French and North American physicians and pharmacists used various cannabis preparations for pain relief and other conditions including malaria, rheumatism, migraine headaches, gout and glaucoma. Cannabis was in the Canadian pharmacopeia until it was added to a list of restricted drugs in 1923 with its possession, cultivation and distribution becoming illegal.  Michael Moore a western herbalist, listed it in his materia medica stating the following as specific uses, marked nervous depression, irritation of the genito-urinary tract, frequent micturition, painful micturition with tenesmus, scalding urine, wakefulness in fevers, insomnia with brief periods of sleep disturbed by unpleasant dreams, spasmodic and painful conditions, depression, mental illusions, hallucinations, cerebral anemia from spasm of cerebral vessels, palpitation of the heart, with sharp stitching pain and menstrual headache with great nervous depression.[18]

Traditional Chinese Medicine and Cannabis:

In TCM, marijuana is known as Da Ma.  According to TCM theory, it restrains the functions of brain marrow and fluids.[19]   It has very strong Qi dispersing action and also clouds the Shen, thus dulls a person’s spirit. [20]  Some Chinese medicine practitioners describe marijuana’s properties as hot and dry, suggesting an overall Yang nature.  Other experts describe marijuana as Yin, citing its historical use for release of anxiety and treatment of pain. [21]

Long-term use of Cannabis due to its hot and dry nature can impact Lung Yin, Qi and dry up body fluids.  This can have a detrimental effect on the smooth flow of Wei Qi, or our ability to fight off evil or pathogenic influences.  A rise in blood pressure has been associated with smoking cannabis that can disturb both Heart  (impairing the Heart Qi) and Lung functions (Lung’s role as the controller of the vessels). It can damage Yin, due to its drying nature leading to deficiency and signs of false heat.

Cannabis is metabolized in the liver and long-term use can be over stimulating to the liver leading to red eyes and a rise in blood pressure (Liver Yang Rising).  This stimulation can lead to Liver Qi Stagnation, Liver Heat, and Liver Wind.  Furthermore due to its hot and dry nature it can lead to a deficiency in Liver Yin and Blood producing symptoms such as dry eyes, dry throat and mouth, and night sweats. Long term Liver Qi Stagnation reverse course and also harm the digestive system, causing Spleen Qi Deficiency.

The Heart houses the Shen, and a disturbance of the Heart can result in impairment of sensory input related to long-term cannabis smoking. Disturbance of the Heart and Blood can result in short and long term memory loss.  Cannabis increases the levels of melatonin temporarily drawing heavily upon the kidney and adrenals resulting in adrenal stress. In TCM repeated melatonin stimulation can result in deficiency of Kidney Yin, Kidney Yang and Jing Essence. As a practitioner of Traditional Chinese Medicine it is necessary to ameliorate these effects, ensuring that patterns be addressed and modulated through the addition of herbal and holistic therapies.

Contraindications:  From a TCM perspective Cannabis taken internally has a hot energy and in conditions with heat or “fire” the use of Cannabis needs to be either avoided or mitigated.  This is a short list of Western conditions where the use of Cannabis would best be avoided:  stroke, pregnancy, breastfeeding, ulcers, any hyper conditions, i.e., hyperthyroidism, etc, menopause, acne or other hot skin conditions (taken internally), diabetes, menstruation*, schizophrenia and other shen disturbances, herpes and shingles (internally)[22]

Medicinal Cannabis:

Medical cannabis (or medical marijuana) refers to the use of cannabis and its constituent cannabinoids such as tetrahydrocannabinol (THC) and Cannabidiol (CBD), as medical therapy to treat disease or alleviate symptoms. Medical cannabis can be administered using a variety of methods, including inhalation, oral digestion of extracts, edibles, capsules and topical treatments. Synthetic cannabinoids are available as prescription drugs in some countries; examples include: dronabinol (available in the United States (US) and Canada) and nabilone (available in Canada, Mexico, the United Kingdom (UK), and the US).

Topical Use of Cannabis:

Historically there are many examples of Cannabis’s use topically.  When used topically Cannabis does not have the psychoactive effects that are felt when it is smoked or ingested.  There is some new and promising research into its topical application especially in the area of skin cancer, inflammation, and for its antimicrobial, antifungal properties.[23]  Many of the products on the market are combined with other herbs or essential oils making it hard to extrapolate and isolate the direct benefit of Cannabis’s effects.  Topical use is mainly through alcohol-based liniments, salves and cannabis oil.  According to the web site of the national group American for Safe Access topical use of cannabis may have the following uses: [24]

Tropical products may produce anti-inflammatory and analgesic or pain relieving effects. Anecdotal reports on topical treatment efficacy include:

• Certain types of dermatitis (including atopic) and psoriasis
• Balm for lips, fever blisters, herpes
• Superficial wounds, cuts, acne pimples, furuncles, corns, certain nail fungus
• Rheumatism and arthritic pains (up to the 2nd degree of arthritis)
• Torticollis, back pains, muscular pains and cramps, sprains and other contusions
• Phlebitis, venous ulcerations
• Hemorrhoids
• Menstruation pains
• Cold and sore throat, bronchitis
• Asthmatic problems with breathing
• Chronic inflammation of larynx (application in the form of a Priessnitz compress)
• Migraine, head pains, tension headaches

There is a historical record of cannabis’s topical uses.  In Tibetan medicine cannabis has its roots in the original shamanic religion of Tiber, Bon and in early Tantric teaching.  Cannabis has been an enduring component of Tibetan pharmacopoeias since ancient times.  A topical treatment was made using Embelia ribes, Allium sativum, Butea frondosa, Cannabis sativa, Iris ensata, and Artemisia nestita, along with musk for treating itchy skin.

In Thailand, Cannabis was combined with Artemisia vulgaris, Myristica sp., Piper nigrum, Zingiber officinale, Cinnamomum, Salacca flavescens, along with alcohol and made into a tincture that was used to treat hemorrhoids, laryngeal polyps and ulcers in the intestinal and genital areas.

In Malaysia, Hydnocarpus anthelmintica and Cannabis were macerated in alcohol and used topically for treatment of leprosy.  In Cambodia, Cannabis, Tepiru bark, Mitagyna, Cinnamomum, Walsura villosa and Aegle marmelos, was macerated for several days and used to treat stiffness following childbirth. [25]  In Western herbal tradition rheumatism oil (1856) was made from Cannabis, poppy and henbane to relieve pain.

In Arabic medicine Cannabis has a long and vast history of topical use.  It was used to treat pityriasis rosea and lichen planus, by using the fresh juice as a wash or oil from the seeds.   There was also mention of cannabis oil being used for treating vitiligo and leprosy. The leaves of the cannabis was also used as a hair rinse to stimulate hair growth.  Between the 11^th and 12^th centuries there is documentation that the juice of the hemp leaves were used to cure abscesses and an “oily wax” made from hemp seed oil was applied to tumors.  The oil was used as a painkiller for earaches, for soothing neurological pain and the boiled leaves was used to wash the body to kill lice, nits and other parasites.[26]

Recent exploration by medical researchers and practitioners have pointed to topical administration of selective cannabinoid receptor agents to have analgesic effects in animal models of inflammatory and neuropathic pain especially for the control of breakthrough pain. [27] A 50/50 mixture of CBN and CBD in the form of transmucosal spray were reported to assist pain in multiple sclerosis.  The topical administration of selective cannabinoid receptor agents has been demonstrated to have analgesic effects in animal models of inflammatory and neuropathic pain (formalin, carrageenan hyperalgesia, and partial nerve injury), especially for the control of breakthrough pain.[28]

Cannabis sativa subspecies Indica tends to have a higher concentration of CBD than Cannabis sativa subspecies sativa.  There has been a resurgence of interest in high CBD containing strains recognizing that these are preferable for many medicinal uses.  Now there are several strains available that have much higher percentage of CBD vs. TCH. [29]  A recent study reported that topically administered cannabinoid agonists may reduce pain without the dysphoric side effects and abuse potential of centrally acting cannabimimetic drugs.[30]

It has been suggested that cannabis is effective for psoriasis and eczema, yet on the flip side it can also cause contact dermatitis.  A 1983 article in the Western Journal of Medicine noted that many people who have a sensitivity or an allergic reaction to airborne plant pollens, including some in similar botanical families, may develop contact dermatitis or urticaria (hives) as a result of prolonged exposure to cannabis (such as trimming, or other work in the industry that requires handling.

Preparation of Cannabis salve and Cannabis Liniment:

This section will cover the making of salve (fat based) and liniment (alcohol based) topical products.  I have presented two methods for making salve.  The first uses a process called decarboxylization.  There is some debate about the destruction of terpenes and other cannabinoids during the heating process, which might enhance cannabis’s pharmaceutical benefits.  The second method of salve making is done through a gentle heating process.  The process of making liniment is also presented with two options; one based on decarboxylization and the other involves no heat.

Cannabis salve using decarboxylization:  There are 2 steps in making cannabis salve.  The first step is the process of heating the cannabis in the oven and the second step involves gently cooking the cannabis in a fat to extract the chemical constituents.  The use of decarboxylization is based on the rational that cannabinoids like THC and CBD are inactive in the plant material, and in order to make them active you have to convert the inactive form to the active form, a process call decarboxylization. THCA is converted to THC and CBDA to CBD when the dried plant material is heated. Several authors have suggested that an oven temperature for maximizing CBD’s is 340° F for 5 minutes. A ratio of ¾ leaf to ¼ bud can be used, but many products are made from leaf alone.

The traditional method of making salve is base on the following proportions-1 oz herb to 1 cup of fat (coconut oil, ghee, tallow, or other vegetable based oil).

1. Grind the cannabis in a blender to a powder.
2. Spread the cannabis in a shallow ovenproof pan.
3. Bake the cannabis at 340 F for 5 minutes, stirring occasionally.
4. When properly decarboxylated, the cannabis will be darker, dry, and crumble easily. Your kitchen will smell strongly, so good ventilation is a must.
5. Combine the decarburized cannabis with the slightly heated oil.
6. Maintain temperature on low for up to 24 hours.
7. Once finished strain the cannabis from the fat using a fine mesh, a yogurt cheese maker works well.
8. When done return the fat to the pan.
9. Heat slightly -adding 1 oz of beeswax per cup of fat.
10. Heat until beeswax is melted.
11. Remove from heat and let cool slightly; at this point you can add essential oils that reinforce the medicinal action of the salve.
12. Pour into finish container and let cool to become solid.

The second method does not involve heating the cannabis separately.  Using the same proportions as above, 1 oz of herb to 1 cup of fat, grind the cannabis and combine with fat in a container that can withstand heat, in this case you need to use a solid fat, such as coconut oil, ghee or tallow.  Add 6 cups of water, and cook at slow temperature, keeping under 120-140 degrees for 24 to 48 hours, or longer. Once finished strain the cannabis from the fat and water mixture, using a fine mesh, a yogurt cheese maker works well.   Then put the fat and water mixture in the refrigerator, until fat solidifies.  Remove the solidified fat and add to a pan.  Heat slightly adding 1 oz of beeswax per cup of fat.  Heat until beeswax is melted. Remove from heat and let cool slightly; at this point you can add essential oils.  Pour into finish container and let cool down to become solid.

The use of liniment made from an alcohol based cannabis tincture can be used for relief of muscle spasms and pain.   According to Michael Moore’s Materia Medica; a tincture alcohol rate of [Fresh Herb, 1:2, Dry Herb, 1:5, 95% alcohol] is the preferred. [31]  Two methods are described for making an alcohol-based tincture.  There is some debate as to the whether the cold or hot methodology leads to more effective medicine, particularly if the presences of cannabinoids is important in its ultimate efficacy.

Liniment made using the cold method:

1. Using a combination of 75% leaf to 25% shake or bud as potential ratio.
2. Grind 100 milligrams of cannabis and add to a mason jar.  Depending upon whether you are using fresh or dried Cannabis, you will need to fill the jar with 190 ml (fresh) or 475 ml (dried) of grain alcohol, then top it off with either 10 ml (fresh) or 25 (dried) ml of filtered water.
3. Shake jar [vigorously] one or two times a day for 2 weeks [or leave it until there is no green color left in the plant matter]
4. Strain through metal tea strainer or silkscreen.

Liniment made using heat:

In this case use only dried plant material.

1. Grind 100 milligrams of cannabis, using suggested leaf and bud ratios.
2. Place Cannabis in a shallow pan or aluminum foil – bake at 325°F for 5 minutes.
3. Remove from oven and place cannabis in a mason jar, adding 500 ml of alcohol.
4. Place jar in pan filled with water.  Simmer in a water bath for 20 minutes. Maintain temperature of 110 to 140, using a thermometer.  Do not boil just maintain a slow simmer.
5. Strain the mixture and store.  You will lose volume due to evaporation.

Examples of recipes for topical uses:

Cannabis Salve-an analgesic topical treatment for pain relief, muscles spasms,

rheumatism, arthritis, menstrual cramps and migraines

Ingredients:

1 oz of cannabis leaf and shake

1 cup of Coconut oil, wound healing

1 oz of beeswax,

1 oz of Arnica oil*, soothes muscle aches, reduce inflammation, and heal wounds

1 oz of St. Johns Wort oil*, wound healing and reduces inflammation

Suggested essential Oils:

Eucalyptus, analgesic

Wintergreen, analgesic

Cinnamon increases blood circulation

1. Grind the cannabis in a blender to a powder.
2. Spread the cannabis in a shallow ovenproof pan.
3. Bake the cannabis at 340 F for 5 minutes, stirring occasionally.
4. When properly decarboxylated, the cannabis will be darker, dry, and crumble easily. Your kitchen will smell strongly, so good ventilation is a must.
5. Combine the decarburized cannabis with the slightly heated coconut oil.
6. Maintain temperature on low for up to 24 hours.  Coffee warmers work well.
7. Once finished strain the cannabis from the fat using a fine mesh, a yogurt cheese maker works well.
8. When done return the fat to the pan, adding one oz of Arnica and St. Johns Wort oil.
9. Heat slightly -adding 1 oz of beeswax.
10. Heat until beeswax is melted.
11. Remove from heat and let cool slightly; at this point you can add essential oils that reinforce the medicinal action of the salve.
12. Pour into finish container and let cool to become solid.

Cannabis Liniment is an alcohol based topical-used to stop pain, reduces swelling and inflammation.

4 oz. Cannabis Tincture

2 oz. Arnica tincture-soothes muscle aches, reduce inflammation, and heal wounds

2 oz. St. Johns Wort tincture-relives nerve pain

Suggested essential Oils:

Eucalyptus, analgesic

Wintergreen, analgesic

Cinnamon increases blood circulation

Liniment made using the cold method:

1. Using a combination of 75% leaf to 25% shake or bud.

1. Grind 100 milligrams of cannabis and add to a mason jar.  Depending upon whether you are using fresh or dried Cannabis, you will need to fill the jar with 190 ml (fresh) or 475 ml (dried) of grain alcohol, then top it off with either 10 ml (fresh) or 25 (dried) ml of filtered water.
2. Shake jar [vigorously] one or two times a day for 2 weeks [or leave it until there is no green color left in the plant matter]
3. Strain through metal tea strainer or silkscreen.
4. Add the remaining ingredients and shake well.  Put into spray bottle.